Percutaneous nephrolithotomy in octogenarians and beyond: How old is too old?
Objective: To specifically report perioperative characteristics and outcomes in patients 80 years and older undergoing percutaneous nephrolithotomy (PCNL). PCNL has been established as feasible in the elderly; however, to our knowledge no one has specifically reported feasibility in patients 80 year...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2015-10-01
|
| Series: | Asian Journal of Urology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S221438821500096X |
| _version_ | 1818305218952036352 |
|---|---|
| author | Bradley Morganstern Riccardo Galli Piruz Motamedinia David Leavitt Mohamed Keheila Eric Ghiraldi David Hoenig Arthur Smith Zeph Okeke |
| author_facet | Bradley Morganstern Riccardo Galli Piruz Motamedinia David Leavitt Mohamed Keheila Eric Ghiraldi David Hoenig Arthur Smith Zeph Okeke |
| author_sort | Bradley Morganstern |
| collection | DOAJ |
| description | Objective: To specifically report perioperative characteristics and outcomes in patients 80 years and older undergoing percutaneous nephrolithotomy (PCNL). PCNL has been established as feasible in the elderly; however, to our knowledge no one has specifically reported feasibility in patients 80 years and older.
Methods: We retrospectively reviewed perioperative data of octogenarians who underwent PCNL at a high stone volume single institution, and matched them to patients <65 years of age by stone burden and sex. Patient demographics, perioperative outcomes and postoperative complications were compared.
Results: Thirty-three octogenarians (mean age 83.6 years) with 36 renal units were matched to 67 controls (mean age 48.6 years) with 72 renal units. Octogenarians had a higher mean American Society of Anesthesiologists (ASA) score, more comorbidities, and worse renal function. There were no differences in operative characteristics, length of hospital stay or stone free rates. Of the patients with preoperative urinary decompression (ureteral stent or nephrostomy tube) prior to PCNL, the elderly were more likely to have a history of urosepsis. Octogenarians did not experience more minor Clavien (I – II) or major Clavien (IIIa – IVb) complications.
Conclusion: Octogenarians who undergo PCNL were more likely to have cardiovascular comorbidities and a prior history of sepsis. Despite these risk factors, in appropriately selected patients PCNL can be safely and successfully performed in octogenarians without increased perioperative complications relative to a younger cohort. |
| first_indexed | 2024-12-13T06:23:06Z |
| format | Article |
| id | doaj.art-45a4498c11f244938c2223aeec511d46 |
| institution | Directory Open Access Journal |
| issn | 2214-3882 |
| language | English |
| last_indexed | 2024-12-13T06:23:06Z |
| publishDate | 2015-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Urology |
| spelling | doaj.art-45a4498c11f244938c2223aeec511d462022-12-21T23:56:48ZengElsevierAsian Journal of Urology2214-38822015-10-012420821310.1016/j.ajur.2015.08.005Percutaneous nephrolithotomy in octogenarians and beyond: How old is too old?Bradley MorgansternRiccardo GalliPiruz MotamediniaDavid LeavittMohamed KeheilaEric GhiraldiDavid HoenigArthur SmithZeph OkekeObjective: To specifically report perioperative characteristics and outcomes in patients 80 years and older undergoing percutaneous nephrolithotomy (PCNL). PCNL has been established as feasible in the elderly; however, to our knowledge no one has specifically reported feasibility in patients 80 years and older. Methods: We retrospectively reviewed perioperative data of octogenarians who underwent PCNL at a high stone volume single institution, and matched them to patients <65 years of age by stone burden and sex. Patient demographics, perioperative outcomes and postoperative complications were compared. Results: Thirty-three octogenarians (mean age 83.6 years) with 36 renal units were matched to 67 controls (mean age 48.6 years) with 72 renal units. Octogenarians had a higher mean American Society of Anesthesiologists (ASA) score, more comorbidities, and worse renal function. There were no differences in operative characteristics, length of hospital stay or stone free rates. Of the patients with preoperative urinary decompression (ureteral stent or nephrostomy tube) prior to PCNL, the elderly were more likely to have a history of urosepsis. Octogenarians did not experience more minor Clavien (I – II) or major Clavien (IIIa – IVb) complications. Conclusion: Octogenarians who undergo PCNL were more likely to have cardiovascular comorbidities and a prior history of sepsis. Despite these risk factors, in appropriately selected patients PCNL can be safely and successfully performed in octogenarians without increased perioperative complications relative to a younger cohort.http://www.sciencedirect.com/science/article/pii/S221438821500096XPercutaneous nephrolithotomyElderlyPercutaneous stone extraction complicationsClavienOctogenariansPercutaneous stone extraction |
| spellingShingle | Bradley Morganstern Riccardo Galli Piruz Motamedinia David Leavitt Mohamed Keheila Eric Ghiraldi David Hoenig Arthur Smith Zeph Okeke Percutaneous nephrolithotomy in octogenarians and beyond: How old is too old? Asian Journal of Urology Percutaneous nephrolithotomy Elderly Percutaneous stone extraction complications Clavien Octogenarians Percutaneous stone extraction |
| title | Percutaneous nephrolithotomy in octogenarians and beyond: How old is too old? |
| title_full | Percutaneous nephrolithotomy in octogenarians and beyond: How old is too old? |
| title_fullStr | Percutaneous nephrolithotomy in octogenarians and beyond: How old is too old? |
| title_full_unstemmed | Percutaneous nephrolithotomy in octogenarians and beyond: How old is too old? |
| title_short | Percutaneous nephrolithotomy in octogenarians and beyond: How old is too old? |
| title_sort | percutaneous nephrolithotomy in octogenarians and beyond how old is too old |
| topic | Percutaneous nephrolithotomy Elderly Percutaneous stone extraction complications Clavien Octogenarians Percutaneous stone extraction |
| url | http://www.sciencedirect.com/science/article/pii/S221438821500096X |
| work_keys_str_mv | AT bradleymorganstern percutaneousnephrolithotomyinoctogenariansandbeyondhowoldistooold AT riccardogalli percutaneousnephrolithotomyinoctogenariansandbeyondhowoldistooold AT piruzmotamedinia percutaneousnephrolithotomyinoctogenariansandbeyondhowoldistooold AT davidleavitt percutaneousnephrolithotomyinoctogenariansandbeyondhowoldistooold AT mohamedkeheila percutaneousnephrolithotomyinoctogenariansandbeyondhowoldistooold AT ericghiraldi percutaneousnephrolithotomyinoctogenariansandbeyondhowoldistooold AT davidhoenig percutaneousnephrolithotomyinoctogenariansandbeyondhowoldistooold AT arthursmith percutaneousnephrolithotomyinoctogenariansandbeyondhowoldistooold AT zephokeke percutaneousnephrolithotomyinoctogenariansandbeyondhowoldistooold |